What to Know About Mental Health if You’re LGBTQ

If you’re LGBTQ — lesbian, gay, bisexual, transgender or nonbinary, or queer — your gender and sexuality can affect your mental health and wellness. There are external things that might affect you more than a straight, cisgender person (someone whose biological sex aligns with their gender identity).

In general, LGBTQ people can be at a higher risk of having a mental health condition than straight people. Not because of their sexual orientation or gender identity but because of the discrimination and bias they might face.

LGBTQ adults are more than twice as likely to have conditions like depression or anxiety than straight adults. For transgender folks, that number is even higher. LGBTQ kids and teens also face a greater chance of both anxiety and depression.

Possible Causes

Researchers don’t know exactly why LGBTQ people have this higher risk of having mental health conditions. The most common explanation is the minority stress theory, which holds that being part of a sexual or gender identity minority — whether that’s lesbian, gay, bisexual, transgender, queer, or nonbinary — leads to more discrimination from society.

This, in turn, leads to greater mental stress for members of the minority group, says Amir K. Ahuja, MD, president of the American Psychiatric Association’s Caucus of LGBTQ Psychiatrists and the director of psychiatry at the Los Angeles LGBT Center. “Other issues that contribute to the higher risk are that LGBTQ people statistically make less money than their cisgender, heterosexual peers, and can often have smaller networks of support,” he says. This is another result of the bias that LGBTQ people often meet with in everyday life. It’s not necessarily the result of their gender identity.

Things That Can Affect Your Mental Health

Lots of things can influence your mental health as an LGBTQ person.

Coming out

This when you share your gender identity or sexuality with someone else. Coming out can influence your relationships and experiences.

Society is more accepting now than in the past, a positive trend that has encouraged kids and teens to come out at younger ages. If you’re not in a supportive environment when you take this step, it can have a negative effect on your mental health.

When it’s dangerous to come out — like in a hostile family that you depend on for support — mental health care providers can help you “process this and find support in safe spaces by connecting with others,” Ahuja says. For example, they might encourage you to come out to a select group of “safe” people and avoid telling the world at large for your own safety.

For most people, coming out is a huge relief and should be welcomed when you’re ready to do it, Ahuja says. He adds that there’s clear evidence that coming out can be good thing for your mental health, as it can lower stress, boost resilience, and help create a sense of belonging.

Substance use and abuse

Substance abuse is a major concern for LGBTQ people. Sometimes it’s used to self-medicate or as a way to cope. Lesbian, gay, and bisexual adults are almost two times as likely as straight adults to deal with substance use. That number is even higher in trans individuals.

Ahuja says that substance use is often used as a way to help people manage trauma and stress. Some of this stress is a result of the discrimination members of this community face.

Access to Mental Health Care

LGBTQ people may face obstacles to accessing mental health care services.

Cultural awareness and doctor bias

Providers don’t always do a good job when seeing and treating LGBTQ people. Ahuja blames that on a lack of LGBTQ education in fields like medicine, social work, and psychology. As a result, he says, these professionals don’t always have an understanding of what it means to be LGBTQ.

If you’re LGBTQ, there’s also a chance you could deal with harassment, even at the doctor’s office. Some people choose not to share their gender identity or sexuality with their doctor because they’re afraid of the potential for discrimination or bias or have had these experiences in the past.

Racial and economic barriers

Because the LGBTQ community includes a variety of people, both race and finances can affect the quality of care you get or even your ability to access these services. For example, 60% of Black LGBTQ youth who wanted mental health services weren’t able to get them, according to the Trevor Project, a crisis intervention and suicide prevention organization for LGBTQ+ youth under 25.

Ahuja says that belonging to more than one minority group can make these issues worse, especially when it comes to accessing care and the level of care you might get. How much money you make, your level of education, and what you do for work can also affect the care you get.

And the quality of care you get is very important. Untreated or undertreated gender dysphoria — a negative feeling a person has because their biological sex and their gender identity don’t match — can worsen mental health conditions.

How to Find a Supportive Provider

Having a LGBTQ-friendly provider can help. Ahuja says that although much work still needs to be done, as a whole, LGBTQ health care and mental health care have evolved in recent years. “There are more resources than ever, and it is important that patients and practitioners are aware of these resources so that the LGBTQ community can get the high quality, competent care it deserves,” he says.

When you start to look for an inclusive health care provider, think about what you want in a doctor. If you’d feel more comfortable with an LGBTQ doctor, sometimes you can find out by reading their profile on the provider website.

You can also find providers who are competent and comfortable with LGBTQ health care by gathering referrals. Search through mental health service directories to see if the provider in question has experience working with LGBTQ patients. “Word of mouth” from social media communities and groups may also be helpful.

Ahuja suggests checking these directories:

• Outlist, from OutCare, at www.outcarehealth.org.
• GLMA: Health Professionals Advancing LGBTQ Equality at www.glma.org
• AGLP: The Association of LGBTQ Psychiatrists, at www.aglp.org
• Healthcare Equality Index from The Human Rights Campaign, which rates facilities and hospitals on LGBTQ-friendly care, at www.hrc.org/resources/healthcare-equality-index

Large health care centers in big cities can be hubs of information and care. “These include Howard Brown in Chicago, Callen-Lorde in New York City, and the Los Angeles LGBT Center,” Ahuja says.

The Mazzoni Center in Philadelphia is another good option. You can also check with LGBTQ organizations in your area.